I now have enough to give you a thorough, well-integrated answer.
Putting Your Full Picture Together
Here is every symptom you have described across both messages:
| Symptom | Duration |
|---|
| Undigested food in stool (bhindi in 8 hours) | 2-3 months |
| Red stool (dragon fruit - harmless) | 2 days |
| Alternating stool - sometimes normal, sometimes loose | 2-3 months |
| Audible gut sounds (borborygmi) | Ongoing |
| Mild abdominal tenderness on palpation | Ongoing |
| Weight gain | Ongoing |
This pattern fits IBS-Mixed (IBS-M) very closely - and here is how each symptom maps to it.
IBS-M: What It Is
IBS (Irritable Bowel Syndrome) is a functional gut-brain disorder - meaning the gut's structure looks normal, but the way it functions is disrupted. The Mixed subtype (IBS-M) is characterized by alternating loose and normal stools, and is one of the most common subtypes.
- Recurrent abdominal pain at least 1 day/week in the last 3 months
- Associated with 2 or more of the following:
- Related to defecation
- Change in stool frequency
- Change in stool form/appearance
You have been having altered stool form and frequency for 2-3 months - that alone checks the box.
Why Each Symptom Happens
1. Alternating loose/normal stools
In IBS-M, gut motility is inconsistent. Sometimes the intestine moves food too fast (loose stool, rapid transit - which also explains seeing undigested bhindi), and other times it slows down (normal or harder stool). This is a hallmark of IBS-M.
2. Audible gut sounds (borborygmi)
These loud gurgling sounds happen when gas and fluid move through the intestines faster than normal or with more turbulence. In IBS, the gut is hypersensitive and hyperreactive - it contracts more than usual in response to food, stress, or hormones. (Harrison's Principles of Internal Medicine 22E)
3. Mild tenderness on palpation
This is well-documented in IBS. As
StatPearls/NCBI states:
"Physical examination is typically normal in IBS; however, some patients may experience tenderness upon palpation." The most common site is the left lower quadrant (over the sigmoid colon). This happens because of
visceral hypersensitivity - the gut's pain nerves are overreactive, so even normal gas or movement causes discomfort.
4. Rapid transit (undigested bhindi in 8 hours)
Consistent with IBS-D/M episodes where gut motility speeds up, leaving no time for proper digestion or absorption.
5. Weight gain
This is an important point. IBS does not cause weight loss - that would be a red flag. Weight gain alongside IBS symptoms is typically due to:
- Bloating and gas retention making the abdomen feel larger
- Dietary compensations - eating more bland/comfort foods, or eating frequently to manage symptoms
- Reduced physical activity due to discomfort
- Occasionally associated with hypothyroidism, which also causes weight gain + constipation-type symptoms and slower gut function on some days
What Else Could It Be? (Differential Diagnoses)
Even though IBS-M is the most likely explanation, these must be ruled out before confirming that diagnosis:
| Condition | Why It Overlaps | Key Differentiator |
|---|
| Celiac disease | Rapid transit, loose stools, bloating | Blood test: anti-tTG IgA antibody |
| SIBO (Small Intestinal Bacterial Overgrowth) | Bloating, borborygmi, alternating stools | Hydrogen breath test |
| Hypothyroidism | Weight gain + gut slowness + bloating | TSH blood test |
| IBD (Crohn's/Ulcerative Colitis) | Tenderness, loose stools, chronic | Colonoscopy, CRP, stool calprotectin |
| Bile acid malabsorption | Watery loose stools, rapid transit | SeHCAT scan or FGF19 blood test |
What You Should Do Next
Step 1 - Blood tests to start with:
- TSH (thyroid function)
- CBC (complete blood count)
- CRP / ESR (inflammation markers)
- Anti-tTG IgA (celiac screen)
- Stool calprotectin (gut inflammation marker)
- Blood glucose / HbA1c
Step 2 - See a gastroenterologist who can decide if you need:
- Hydrogen breath test (for SIBO or lactose intolerance)
- Colonoscopy (to rule out IBD or other structural issues)
Step 3 - In the meantime:
- Keep a food + stool diary (time of eating, what you ate, stool consistency, sounds/pain)
- Eat slowly and chew thoroughly
- Avoid known gut irritants: excess raw vegetables, very spicy food, caffeine, fizzy drinks, fried food
- Manage stress - the gut-brain axis is a real and well-established connection in IBS
Important: The weight gain + alternating stools combination is worth investigating for hypothyroidism specifically, since that is treatable with a simple daily tablet and can explain several of your symptoms together. Ask your doctor for a TSH test as a first step.